Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Journal of radiation research
A model-based selection of oral cancer patient for passive scattering proton beam therapy
BACKGROUND AND PURPOSE: To identify patients with oral cancer (OC) who benefit from proton therapy versus photon therapy using a model-based approach (MBA) to reduce late adverse events. MATERIAL/METHODS: Passive scattering proton beam therapy (PSPT) and volumetric modulated arc therapy (VMAT) plans were established for 40 patients with OC, consisting of a dose of 70 Gy (relative biological effectiveness) in 35 fractions. At least 95% of the planning target volume received 95% of the prescribed dose, and the dose to the organs at risk was restricted to be as low as possible. Normal tissue complication probability (NTCP) was used to estimate the risk of late adverse events, including dysgeusia, xerostomia and osteoradionecrosis of the mandible. Patients who were considered as candidates for PSPT were selected if the NTCP difference between both plans (ΔNTCP) exceeded the threshold defined in the Dutch national indication protocol. RESULTS: PSPT reduced the doses to the spinal cord, pharynx, oral cavity and contralateral salivary glands compared with VMAT. PSPT was also superior for the risk evaluation of each late adverse event calculated by incorporating dose metrics and patient baseline risk factors. For the MBA using ΔNTCP and the thresholds, PSPT was indicated in 24 of the 40 cases, and the remaining 16 cases were considered to be equivalent to VMAT. CONCLUSION: MBA was used to select OC cases that were candidates for PSPT. Compared with VMAT, the risk of expected late adverse events was significantly reduced with PSPT, and 60% of patients were considered eligible for PSPT.
26 July 2026
Read appraisal →Journal of neural engineering
Cortical-SSM: a deep state space model for motor imagery decoding from EEG signals
Objective.Classification of electroencephalogram (EEG) signals obtained during motor imagery (MI) has substantial application potential, including for communication assistance and rehabilitation support for patients with motor impairments. These signals remain inherently susceptible to physiological artifacts (e.g. eye blinking, swallowing), which pose persistent challenges. Although Transformer-based approaches for classifying EEG signals have been widely adopted, they often struggle to capture fine-grained dependencies within them.Approach.To overcome these limitations, we propose Cortical-SSM, a novel architecture that extends deep state space models to capture integrated dependencies of EEG signals across temporal, spatial, and frequency domains. We validated our method across two large-scale public MI EEG datasets containing more than 50 subjects.Main results.Our method outperformed baseline methods on the two benchmarks. Furthermore, visual explanations derived from our model indicate that it effectively captures neurophysiologically relevant regions of EEG signals.Significance.These results indicate that Cortical-SSM provides a robust and interpretable alternative to attention-based architectures for MI EEG decoding. By enabling physiologically grounded feature learning, our method advances the reliability of subject-independent EEG classification and supports the development of practical and clinically deployable brain-computer interface systems.
26 July 2026
Read appraisal →Nature communications
Sensory-guided human-machine joint learning accelerates the acquisition of motor imagery brain computer interface control
Brain-computer interfaces (BCIs) offer the potential to restore function and augment human capabilities. However, non-invasive electroencephalography (EEG)-based BCIs still face challenges in learning efficiency and control precision, particularly for naïve users performing complex tasks. Here, we present a sensory-guided joint learning framework that integrates human motor learning with adaptive machine learning to improve BCI training and performance. In 31 BCI-naïve participants, the framework enabled rapid skill acquisition, achieving average online discrete accuracies of 86.0% for one-dimensional (1D) and 77.5% for two-dimensional (2D) motor imagery tasks, along with continuous control accuracies of 77.5% (1D) and 66.9% (2D). Mechanistically, tactile guidance reduced user exploration and accelerated neural adaptation, while sample reweighting aligned decoder updates with human learning trajectories. By coupling reinforcement-driven neural plasticity with adaptive algorithmic optimization, this framework advances BCI training from passive calibration to active human-machine joint learning, enabling practical and scalable neural interfaces for communication and rehabilitation.
17 July 2026
Read appraisal →European journal of cardiovascular nursing
The psychological effects of interventions targeting informal caregivers of patients with cardiovascular disease-a systematic review.
AIMS: To explore the psychological effects of interventions aimed at supporting informal caregivers involved in the care and treatment of patients with cardiovascular disease. METHODS AND RESULTS: Databases (PubMed, CINAHL, Embase, Cochrane Library, and PsycInfo) were searched for studies in accordance with the Cochrane Handbook guidelines. Inclusion criteria were: caregivers of patients with one or more cardiovascular diseases, patient and caregiver >18 years, caregivers included in the intervention, and, reporting of psychological outcomes specific to caregivers. Study designs were randomized controlled trials with a follow-up periods of >2 months. The RoB 2.0 bias assessment tool was used to assess risk of bias. Fifteen studies from nine countries were identified. Most interventions consisted of multiple components including educational face-to-face sessions, telephone support, and/or written resources. The analysis showed inconsistent results on caregiver outcomes, but significant improvements were reported in eight studies in at least one caregiver outcome. Analysis indicated that the studies providing more frequent contact with caregivers and patients were more likely to report significant improvements in caregiver outcomes. Risk of bias was judged as low in three studies, some concerns in nine studies, and as high in three studies. CONCLUSION: Due to inconsistency in results, this review yield uncertainty about whether interventions targeting caregivers of patients with cardiovascular disease improve caregivers' psychological outcomes. Therefore, further research is needed to develop effective interventions for caregivers, as they play a vital role in the daily care and treatment of patients with cardiovascular disease. REGISTRATION: PROSPERO: CRD420250654618.
17 July 2026
Read appraisal →Blood advances
I-STRONG: an integrative, multicomponent treatment approach for chronic pain in pediatric sickle cell disease
Chronic pain affects ∼20% of adolescents living with sickle cell disease (SCD). There is a critical unmet need for evidence-based interdisciplinary approaches for chronic SCD pain treatment. We aimed to (1) use community engagement to adapt an integrative multicomponent treatment program designed to meet the unique needs of chronic SCD pain (ie, Integrative Strong Body and Mind Training [I-STRONG] for SCD), and (2) optimize feasibility and acceptability of I-STRONG through a proof-of-concept trial. Modifications to an existing cognitive behavioral therapy (CBT) and neuromuscular treatment program for chronic widespread pain were informed by semistructured qualitative interviews with adolescents (aged 12-18 years) with chronic SCD pain (n = 12) and their caregivers (n = 12), community advisory boards, and interdisciplinary experts to develop I-STRONG. I-STRONG is a virtual 8-week, 16-session, group intervention combining CBT and neuromuscular exercise training, co-led by experts in psychology and physical therapy. A pilot clinical trial of I-STRONG (n = 12 adolescents; n = 9 caregivers) was conducted to iteratively optimize intervention feasibility and acceptability. Community engagement strategies informed systematic adaptations for access, engagement, relevance, satisfaction, and sense of belonging to meet the unique needs of youth experiencing chronic SCD pain. Pilot testing demonstrated high levels of feasibility (95% completion, 97% intervention fidelity, 92% retention), moderate to high acceptability, and safety. Over 82% of adolescents reported improvements in pain after treatment and at 3-month follow-up. Preliminary evidence suggests that I-STRONG is a promising approach for management of chronic pain in pediatric SCD. A planned multicenter, randomized controlled trial will evaluate I-STRONG's efficacy for pain reduction. This trial was registered at www.clinicaltrials.gov as #NCT06110754.
14 July 2026
Read appraisal →Cancer causes & control : CCC
Post-diagnosis physical activity in relation to mortality among gynecological cancer survivors
PURPOSE: Physical activity may play a supportive role in cancer survivorship. However, evidence on the association between post-diagnosis physical activity and mortality among women with gynecological cancer remains limited and inconsistent. METHODS: We conducted a systematic review of the literature published between 1949 and January 2026. Eligible observational studies were identified, and random-effects meta-analyses were performed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnosis physical activity and all-cause mortality among women diagnosed with gynecological cancer. RESULTS: A total of ten eligible studies on endometrial, ovarian, and cervical cancer were included, collectively reporting 3,867 deaths. High levels of post-diagnosis physical activity, compared with low levels, were associated with lower mortality (HR: 0.65; 95% CI 0.54-0.78). This inverse relationship was evident in both endometrial and ovarian cancer survivors (endometrial cancer: HR: 0.60; 95% CI 0.43-0.83; ovarian cancer: HR: 0.71; 95% CI 0.58-0.86). Medium levels of physical activity tended to be inversely associated with mortality (HR: 0.88; 95% CI 0.76-1.02). CONCLUSION: Higher levels of physical activity after a gynecological cancer diagnosis were associated with improved survival. The results suggest that physical activity may represent a modifiable lifestyle factor with the potential to improve long-term outcomes among gynecological cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: This supports the potential value of integrating physical activity into survivorship care, although further high-quality prospective studies are needed to strengthen causal inference.
6 July 2026
Read appraisal →JMIR formative research
Exploring Informal Caregivers' Perception of the Olera Digital Caregiving Assistance Platform for Dementia Care: Mixed Methods Evaluation Study
BACKGROUND: Informal caregivers of people living with dementia often experience high rates of caregiver burnout while providing care. Although there are many websites and mobile apps available to help caregivers, many do not use digital tools. The Olera platform was developed to be an easily adoptable web-based support tool, connecting caregivers with long-term services and supports, financial assistance, and educational resources. The platform was developed based on the Build-Measure-Learn framework with input from caregiver needs assessments and usability studies. OBJECTIVE: This study aims to evaluate the quantitative and qualitative feedback of informal caregivers of people living with dementia on the second iteration of the Olera platform. The primary objective was to assess caregivers' acceptance of this caregiving platform. The secondary objective was to use qualitative methods to explore (1) the study cohort's challenges in daily caregiving to determine and compare them with prior literature, (2) their experience when using the Olera platform, and (3) their attitudes toward integrating artificial intelligence in caregiver services for future studies and platform development. METHODS: Caregivers were recruited through various sources and screened for eligibility through an initial survey. Participants used the platform for 4 weeks and completed a survey with an adapted Technology Acceptance Survey (TAS) and qualitative open-ended questions at the end of the testing period. TAS responses were summarized with descriptive statistics, while ANOVAs, t tests, and linear regressions were used to compare the differences in the overall TAS scores by caregiver characteristics. Qualitative feedback data on the platform's usefulness were analyzed via a thematic analysis framework approach. RESULTS: A total of 65 caregivers in the United States completed the study, with a mean age of 59.9 (SD 9.8) years. The majority were female (61/65, 95.3%), non-Hispanic or Latino White (45/65, 69.2%), and the adult child of their care recipient (42/65, 64.6%). Evaluation of the Olera platform showed a high acceptance rate, with each TAS item scoring above 5.0 and an overall TAS score of 5.83 (SD 0.85) out of 7. Higher platform use frequency was associated with higher TAS ratings in technology acceptance (F3,61=7.88, P<.001). Thematic analyses elicited the caregiving challenges, evaluation of the Olera platform, and feedback on artificial intelligence-assisted support. CONCLUSIONS: The Olera platform is an example of a beneficial web-based tool, though key features were requested to be included in the next iteration. Additionally, data supported prior findings regarding informal caregiver challenges and the insufficiency of conventional support mechanisms, indicating a need for more innovative digital solutions. Future research and development efforts using the Build-Measure-Learn approach are necessary to further iterate the platform's key features, enhance the tool, involve more informal caregivers in its improvements, and serve as a model for customizable, person-centered online care support.
6 July 2026
Read appraisal →Journal of medical Internet research
Physical Activity Interventions Using Digital Health Interventions for Cancer-Related Fatigue in People With a History of Cancer: Scoping Review
BACKGROUND: Although exercise has been proven effective in alleviating cancer-related fatigue (CRF), traditional face-to-face programs may not be accessible due to physical, temporal, or geographical barriers. Digital health interventions (DHIs) offer scalable alternatives for promoting physical activity; however, evidence synthesizing DHI-based physical activity interventions specifically targeting CRF and their intervention characteristics remains limited. OBJECTIVE: This scoping review aimed to map the types of digital health-based physical activity interventions for managing CRF, to summarize the key characteristics of DHI modalities and CRF outcomes, and to identify knowledge gaps for future research. METHODS: A systematic literature search was conducted across 4 databases (PubMed, EMBASE, Cochrane, and PsycINFO) up to December 2025. Inclusion criteria comprised experimental studies involving adults with a history of cancer, digital exercise interventions, a control group, and fatigue outcomes. Screening and data extraction followed the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) standards. The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42022304285). Interventions were classified using the Evidence Standards Framework (ESF). RESULTS: Thirty-three studies comprising 3443 participants were included, representing 32 interventions. Most were randomized controlled trials (n=30, 91%). Interventions were delivered primarily via mobile apps (11/32, 34%) and wearable devices (8/32, 25%), followed by web-based platforms, videoconferencing, exergaming, and augmented reality. Eighteen interventions (reported in 19 studies) demonstrated statistically significant between-group CRF reductions, predominantly at immediate postintervention assessments. Evidence for sustained benefit beyond 12 months was limited, and only one study evaluated ultra-long-term outcomes, which did not demonstrate maintained improvement. Populations with breast cancer accounted for the largest proportion of participants. Fatigue measurement tools varied substantially, potentially contributing to heterogeneity in effect estimates. Most interventions were classified as ESF tier C, indicating a predominant focus on clinical outcome improvement rather than individual-level self-management and system-level implementation. Wearable device-based interventions showed the highest proportion of significant CRF improvement, whereas mobile app-based interventions reported both significant and nonsignificant results. DHIs lasting more than 12 weeks appeared to be associated with more effective CRF outcomes compared to shorter programs. Direct comparisons between in-person and digital delivery were scarce. CONCLUSIONS: Digital health-based physical activity interventions can reduce CRF in people with a history of cancer, with wearable device and longer-duration interventions showing the most favorable outcomes. However, the current evidence is concentrated in populations with breast cancer, and system-level integration remains unexplored. Future research should prioritize diverse populations with cancer, longer follow-up periods, standardized fatigue measurement, and systematic examination of specific intervention components that contribute to CRF reduction. Ultimately, advancing from individual efficacy trials toward scalable, workflow-integrated digital solutions will be key to sustainable CRF management across diverse oncology settings.
29 June 2026
Read appraisal →Journal of medical Internet research
Effectiveness of a Home-Based and Group-Based Tele-Exercise Program for Breast Cancer Survivors: Pilot Randomized Controlled Trial
BACKGROUND: Breast cancer remains the most prevalent cancer among women globally. Adjuvant therapies can cause adverse effects that compromise physical and mental health. Exercise may mitigate these effects; however, many breast cancer survivors remain insufficiently active. OBJECTIVE: This pilot study aimed to test the effectiveness of a 7-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong. METHODS: We developed a 12-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong; this pilot tested a 7-week abbreviated version. In this 2-group randomized controlled pilot trial, 34 individuals were assessed for eligibility, and 27 were randomized; 24 completed baseline and were included in the modified intention-to-treat analyses (12 per group). The intervention comprised a progressively supervised group-based tele-exercise intervention transitioning to unsupervised sessions, combined with psychological counseling. Outcomes were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, with emphasis on feasibility, acceptability, and preliminary effects. RESULTS: Recruitment was 79.4% (27/34) and baseline-to-post retention was 100% (24/24), with satisfactory attendance (87.7%) and compliance (85.3%) in the intervention group. Acceptability was high. Preliminary signals of improvement were observed in cardiorespiratory fitness (primary outcome), lower-extremity strength, balance, affected-side shoulder range of motion, and health-related quality of life. CONCLUSIONS: This pilot supports the feasibility and acceptability of tele-exercise for breast cancer rehabilitation and provides preliminary evidence to justify a larger trial with longer follow-up to assess sustained effects and broader applicability.
29 June 2026
Read appraisal →Rheumatology international
Pruritus associated with systemic sclerosis: a systematic review of treatment-based clinical trials
This paper aims to examine the latest research on treatments for itch (pruritus) in people with systemic sclerosis (SSc), identify areas where information is lacking, and propose suggestions for future studies.A comprehensive literature search was performed in PubMed and Scopus in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies evaluating therapeutic interventions for pruritus in SSc. Eligible studies included randomized controlled trials, cohort studies, and case series comprising a minimum of three patients. Data extraction encompassed study design, patient demographics, pruritus assessment instruments including validated and non-validated measures, and clinical outcomes. Studies were excluded if they concerned localized scleroderma, irrelevant populations, case reports, systematic reviews, lacking relevant outcome data, or incomplete trials. Ten studies met criteria, evaluating immunomodulatory agents, mast cell stabilizers, opioid receptor antagonist, and lysophosphatidic acid receptor antagonists. Pruritus assessment varied and was often secondary to fibrosis outcomes. Oral lenabasum improved pruritus in a phase II trial; low-dose opioid receptor modulators and rituximab also showed qualitative improvement. Pruritus is a frequently overlooked yet clinically significant symptom in systemic sclerosis (SSc) that negatively impacts patients' quality of life. Existing evidence regarding effective therapeutic options remains limited. Future research should prioritize pruritus as a predefined outcome and utilize validated assessment instruments to inform treatment strategies and enhance patient quality of life.
23 June 2026
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